The Body Covers: The 6th Conference on Retroviruses and Opportunistic Infections

Session 27: Infection Control

Coverage provided by Kent Sepkowitz, M.D.

February 1, 1999

Several studies (Abstract #210-215) addressed various aspects of post-exposure prophylaxis, both following occupational (#210-214) and community/sexual exposure (#214, 215). Studies reported on the tolerability and feasibility rather than the effectiveness. However, one disturbing case report (#210) detailed HIV sero-conversion despite 4-drug treatment (AZT, 3TC, DDI, and IDV) following occupational exposure in a nurse who sustained a needle stick. In this report, the nurse sustained the injury with a 21-gauge butterfly from a source case with an HIV viral load of 1540 and CD4 count of 480. The source case was receiving AZT/3TC and had previously received D4T. He also was infected with HCV, which apparently was also transmitted with the injury. After 6 weeks, the nurse discontinued PEP; one month later, she developed acute symptomatic HIV, with a viral load of >750,000. To date, treatment has resulted in containment of viral load (now undetectable), but a gradual decline of her CD4/CD4 ratio has occurred. This represents the first case of PI failure in PEP.

Other, more optimistic reports demonstrated the feasibility of a national PEP Hotline, PEPLine (phone # 888-448-4911) (#211). In this report, data from 5500 calls was reported, two-thirds of which were from percutaneous exposures. One third of the calls came from the exposed HCW, the other from providers. PEP was recommended in 56% of exposures, generally for 2-drug treatment. Rates of tolerance of 3-drug PEP (21.6% stopped due to side effects) and 2-drug PEP (10.4% stopped) in Italy (poster #212) were comparable to US rates. In a similar system in Canada, community exposures, community needle use, or sexual assault accounted for 25% of all calls (#214). And in San Francisco, a new program offering PEP and counseling for community exposures appeared feasible. Thus far, 328 persons had been screened, and 79% of those who began treatment finished a 4-week course, similar to completion rates in HCW's (#215).

These studies suggest that PEP is feasible in hospitals and the community and that more than three-fourths of persons can finish the regimen. The efficacy of PI-containing regimens remains to be established as the single disturbing report (210) reminds us.

Please note: Knowledge about HIV changes rapidly. Note the date of this summary's publication, and before treating patients or employing any therapies described in these materials, verify all information independently. If you are a patient, please consult a doctor or other medical professional before acting on any of the information presented in this summary. For a complete listing of our most recent conference coverage, click here.

The Body is a service of Remedy Health Media, LLC, 750 3rd Avenue, 6th Floor, New York, NY 10017. The Body and its logos are trademarks of Remedy Health Media, LLC, and its subsidiaries, which owns the copyright of The Body's homepage, topic pages, page designs and HTML code. General Disclaimer: The Body is designed for educational purposes only and is not engaged in rendering medical advice or professional services. The information provided through The Body should not be used for diagnosing or treating a health problem or a disease. It is not a substitute for professional care. If you have or suspect you may have a health problem, consult your health care provider.